Provider Demographics
NPI:1447915889
Name:HOWARD, ANTOINETTE
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:HOWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 PEARSE AVE # UP
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44105-3242
Mailing Address - Country:US
Mailing Address - Phone:216-468-2627
Mailing Address - Fax:
Practice Address - Street 1:4520 PEARSE AVE # UP
Practice Address - Street 2:
Practice Address - City:NEWBURGH HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44105-3242
Practice Address - Country:US
Practice Address - Phone:216-468-2627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
OHCDCA.178216101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist